Provider Demographics
NPI:1821045139
Name:ROSARIO, PETER A (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:A
Last Name:ROSARIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 SAINT MARYS DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0520
Mailing Address - Country:US
Mailing Address - Phone:812-485-6030
Mailing Address - Fax:812-485-6032
Practice Address - Street 1:901 SAINT MARYS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0520
Practice Address - Country:US
Practice Address - Phone:812-485-6030
Practice Address - Fax:812-485-6032
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038767207RP1001X
IN01038767A207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64871742Medicaid
INP00377503OtherRAILROAD MEDICARE
IN000000488749OtherANTHEM
IN100322910Medicaid
C98065Medicare UPIN
KY64871742Medicaid